Healthcare Provider Details

I. General information

NPI: 1518579721
Provider Name (Legal Business Name): ELIZABETH HULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 SAGINAW RD
LINCOLN UNIVERSITY PA
19352-9021
US

IV. Provider business mailing address

621 SAGINAW RD
LINCOLN UNIVERSITY PA
19352-9021
US

V. Phone/Fax

Practice location:
  • Phone: 610-506-4386
  • Fax:
Mailing address:
  • Phone: 610-506-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013780L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: